EP0212370A2 - Surveillance de la respiration - Google Patents

Surveillance de la respiration Download PDF

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Publication number
EP0212370A2
EP0212370A2 EP86110522A EP86110522A EP0212370A2 EP 0212370 A2 EP0212370 A2 EP 0212370A2 EP 86110522 A EP86110522 A EP 86110522A EP 86110522 A EP86110522 A EP 86110522A EP 0212370 A2 EP0212370 A2 EP 0212370A2
Authority
EP
European Patent Office
Prior art keywords
signal
threshold value
patient
amplitude
occurrence
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
EP86110522A
Other languages
German (de)
English (en)
Other versions
EP0212370B1 (fr
EP0212370A3 (en
Inventor
Serge Georges Julien Chaumet
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Kontron Instruments Holding NV
Original Assignee
Kontron Holding AG
Kontron Instruments Holding NV
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Kontron Holding AG, Kontron Instruments Holding NV filed Critical Kontron Holding AG
Publication of EP0212370A2 publication Critical patent/EP0212370A2/fr
Publication of EP0212370A3 publication Critical patent/EP0212370A3/de
Application granted granted Critical
Publication of EP0212370B1 publication Critical patent/EP0212370B1/fr
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Measuring devices for evaluating the respiratory organs
    • A61B5/085—Measuring impedance of respiratory organs or lung elasticity
    • A61B5/086—Measuring impedance of respiratory organs or lung elasticity by impedance pneumography
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/366—Detecting abnormal QRS complex, e.g. widening
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7235—Details of waveform analysis
    • A61B5/7239—Details of waveform analysis using differentiation including higher order derivatives

Definitions

  • the invention relates to a method for monitoring waveforms which characterize the breathing of a patient and for the detection of waveforms with properties which are characteristic of respiratory arrest, the method processing a first electrical signal with a waveform characterizing the patient's breathing and a second that Electrocardiogram of the patient's characteristic electrical signal. Furthermore, an apparatus for performing this method is the subject of the invention.
  • respiratory arrests could be determined at least in principle by monitoring the amplitude of the wave of the respiratory signal and by detecting the intervals in which the amplitude is below a predetermined threshold value.
  • a predetermined threshold value In practice, such a method is not reliable because the amplitude of the cardiovascular artifacts, which is flat and whose amplitude is practically zero, is selected even in the event of a respiratory arrest (respiratory arrest should in principle be indicated by a wave of the respiratory signal) Very often exceed the detection threshold and can therefore give the appearance of normal breathing. If the detection threshold is chosen to be low, there is a risk that breathing stops will go unnoticed.
  • a second known method measures the phase difference between the respiratory signal and the signal characterizing the patient's electrocardiogram. If this difference remains below a predetermined threshold during a predetermined time interval, it is believed that the apparently existing respiratory signal is actually a cardiovascular artifact.
  • a signal is formed which corresponds to the first time derivative of the respiratory signal and the steepness of this signal is checked at time intervals which correspond to the intervals between successive QRS complexes of the signal which characterizes the patient's electrocardiogram . If this slope assumes a negative value several times in succession in the test interval, it is believed that the apparent respiratory signal is actually a cardiovascular artifact.
  • the invention has for its object to provide a method and a device for its implementation, with which the disadvantages of the above-mentioned known methods and devices can be at least partially eliminated, so that reliable respiratory arrest alarms are obtained and despite the presence of cardiovascular artifacts in the Breathing signal can measure the duration of each breath stop with greater precision and sensitivity.
  • the method and the device for its implementation should also be as inexpensive and space-saving as possible, so that their incorporation into a respiratory monitoring system does not cause excessive cost increases.
  • a third electrode 113 can optionally be used as a potential reference.
  • the electrodes shown in FIG. 1 enable the breathing signal to be obtained by measuring the thoracic impedance.
  • This signal can also be obtained by other means, e.g. a sensor for chest stress, a displacement or acceleration sensor, an acoustic transducer or a pneumatic sensor for the detection of pressure changes in a pneumatic mat, etc.
  • a first embodiment of the method according to the invention in the case of normal breathing without breathing stopped is illustrated by the waveforms shown in FIG. 3, in which the time axes are represented by broken horizontal lines.
  • This method is based on two signals from a patient obtained simultaneously: the signal 21, which is characteristic of the electrocardiogram, and the respiratory signal 31. In practice, the latter contains cardiovascular artifacts. Since these artifacts do not have a great influence on the result of the method for the case shown in FIG. 3, the signal 31 does not show such artifacts to simplify the illustration in FIG. 3 .
  • a signal 41 is formed, the waveform of which corresponds to the first time derivative of the waveform of the respiratory signal 31, and a signal 42, the waveform of which corresponds to the integral of the signal 41 over integration intervals, each of which is determined by the interval between two successive QRS -Complexes of the signal 21 are characterized, being reset to zero when each QRS complex occurs. 3 and 4, the occurrence of these QRS complexes is shown by broken vertical lines.
  • the amplitude of the signal 42 at the time of occurrence each QRS complex assuming the end of one of the integration intervals is compared to a threshold 44 for the positive polarity amplitudes and a threshold 46 for the negative polarity amplitudes. If the amplitudes of the signal 42 at the times mentioned do not exceed the threshold value 44 or 46 within a predetermined time interval, an alarm is triggered which indicates that the patient has stopped breathing.
  • the method described above is generally applicable, in the special case shown in FIG. 4, in which the frequency of the respiratory signal 34 corresponds exactly to half the frequency of the EKG signal 21 and, moreover, the signal 34 has an unfavorable phase relationship to the signal 21, however, the procedure is ineffective.
  • the amplitude of the signal 42 always assumes the value zero at the end of each integration interval and gives the impression that there is a respiratory arrest.
  • a signal 43 is additionally formed, the waveform of which corresponds to the integral of the signal 41 over the integration intervals 47, 48, 49 etc., each of these integration intervals being increased by a time period 33 of, for example 200 ms compared to those integration intervals ver which is used for the formation of the signal 42.
  • the amplitude of the signal 43 at the time marking the end of each of these integration intervals 47, 48, 49, etc. is compared with the predetermined threshold values 44 and 46, respectively.
  • the respiratory failure alarm triggered only if the amplitudes of the signal 42 and the amplitudes of the signal 43 at the end of the relevant integration intervals do not exceed the threshold value during a predetermined time interval of, for example, 3 seconds.
  • the amplitudes of the signal 43 exceed the threshold value 46 at the end of the integration intervals and thus reliably prevent the triggering of a false respiratory arrest alarm.
  • the amplitude values of signals 42 and 43 exceed threshold values 44 and 46 at the end of the corresponding integration intervals and reliably prevent the triggering of a false apnea alarm.
  • the waveforms shown in FIG. 5 apply to the first embodiment of the method according to the invention, the time axes being indicated by broken horizontal lines.
  • the method is carried out on the basis of two signals which are simultaneously recorded by a patient: the signal 41 which represents the electrocardiogram and a signal 32 which is obtained by the same means which are also used for the extraction of the respiratory signal 31 in FIG. 3 can be used. Since the signal 32 represents respiratory arrest, its waveform shows cardiovascular artifacts almost exclusively.
  • a signal 51 is formed, the waveform of which corresponds to the first time derivative of the waveform of signal 32, and a signal 52, the waveform of which is characteristic of the integral of signal 41 over integration intervals, each of which is determined by the time period between successive ones QRS complexes of signal 21 are defined, with a reset to zero when each QRS complex occurs.
  • the occurrence of each of these QRS complexes is indicated in FIG. 5 by a dashed vertical line.
  • the amplitude of the signal 52 at the time of occurrence of the individual QRS complexes, which mark the end of one of the integration intervals, is compared with the threshold value 44 for amplitudes with positive polarity and with the threshold value 46 for amplitudes with negative polarity.
  • FIG. 5 shows that the amplitudes of the signal 52 at the points in time defined above are below the threshold values 44 and 46 in a respiratory arrest interval.
  • an alarm is triggered and a respiratory arrest is indicated if the said amplitudes remain below the said threshold values for the duration of a predetermined time interval.
  • a signal 52 is additionally formed in a preferred version, the waveform of which represents the integral of the signal 51 over integration intervals 47, 48, 49 etc., each of these integration intervals versus one of those used to form the signal 52 used integration intervals by which the interval 33 is offset.
  • the amplitude of the signal 53 at the point in time that marks the end of each of these integration intervals 47, 48, 49 etc. is compared with the threshold values 44 and 46, respectively.
  • FIG. 5 shows that the amplitude of the signals 52 and 53 in a respiratory arrest interval at the end of the relevant integration intervals below the Thresholds 44 and 46 are.
  • a breathing arrest alarm is triggered if the said amplitudes remain below the said threshold values for a predetermined time interval.
  • the waveform 12 of a signal indicative of cardiovascular artifacts can be of any shape, but is generally sufficiently periodic to be synchronous with the signal 21 indicative of the electrocardiogram and repeats in form.
  • the waveform 12 of the signal representative of a cardiovascular artifact assumes the same amplitude value at every point in time of its period.
  • the amplitude of point 13 of wave 12 when a QRS complex of signal 21 occurs at time 35 is the same as that of point 15 at time 36 when the next following QRS complex occurs.
  • This last-described property of the waveform of the cardiovascular artifacts is a sufficient condition for the methods according to the invention to enable reliable detection of the respiratory arrests and precise measurement of their duration when monitoring a patient's breathing.
  • Fig. 7 shows a first embodiment of an electronic device for performing a method according to the invention.
  • This device comprises the series arrangement of the following circuits: a differentiation circuit 72, an integration circuit 73, a threshold detector 74 and a bistable flip-flop 79 in the form of a D flip-flop.
  • the breathing signal becomes the input 71 of the differentiating scarf device 72 fed. At its output, this provides a signal which is representative of the first time derivative of the respiratory signal.
  • This signal is fed to the input of the integrator 73. At its output, the latter delivers a signal which is characteristic of the integral of the signal fed to its input over integration intervals which each correspond to the interval between successive QRS complexes of the patient's electrocardiogram.
  • the integrator 73 is reset to zero when each QRS complex occurs by briefly closing a switch 69. This closing of the switch is controlled by a signal which is characteristic of the corresponding QRS complex and which is derived from the signal of the electrocardiogram with the aid of a suitable detector circuit. 7, the closing of the switch 69 is indicated by a broken line 68.
  • the signal supplied by the output of the integrator 73 is fed to a first input 75 of the threshold value detector 74.
  • a voltage which corresponds to a predetermined threshold value is fed to a second output 76 of the threshold value detector 74.
  • the threshold value detector 74 delivers a signal at its output which corresponds to either the logic state "1" or "0". This signal is fed via line 18 to the D input of flip-flop 79.
  • This input of the multivibrator is the one that receives the clock pulses when used in digital circuits.
  • the output of flip-flop 79 is provided on line 81 and is applied to an analyzer circuit (not shown in Figure 7) which triggers a breathing arrest alarm when the output of flip-flop 79 indicates that the amplitudes of the integrator output during a predetermined time interval exceed the threshold do not exceed.
  • the electronic circuit described above enables the implementation of the first variants of the method according to the invention, which is explained above with reference to FIG. 1 has been.
  • a more complete version of the device is shown in Fig. 8. This enables the preferred variants of the method according to the invention to be carried out, which was explained above with reference to FIGS. 3 and 4.
  • FIG. 9 shows a second embodiment of the devices according to FIGS. 7 and 8.
  • the differentiating circuit 72 has been retained, while the other elements shown in FIGS. 7 and 8 have been replaced by a microprocessor 93, which also has the Performs the function of the analyzer mentioned (but not shown) with reference to FIGS. 7 and 8.
  • An analog-digital converter 118 is inserted between the output of the differentiating circuit 72 and an input 119 of the microprocessor 93. Pulses corresponding to the QRS complexes and arriving on line 92 are applied to the "interrupt" input of microprocessor 93.
  • This microprocessor performs the integration function by accumulating the values of the output signal of the differentiating circuit 72, which are obtained every 1 ms during the integration intervals, and are reset to zero at the end of each of these intervals.
  • the microprocessor 93 also compares the result of these integration processes with detection thresholds and optionally triggers an alarm which is made audible via a loudspeaker 82 which is activated by an output signal of the microprocessor 93 occurring on a line 94.
  • FIG. 10 shows a fully digitized version of the device according to FIG. 9.
  • a microprocessor 103 also performs the function of the differentiating circuit 72.
  • the respiration signal arriving on line 71 is fed to the input of an analog-digital converter 118, the output of which is connected to the input 119 of the microprocessor.
  • Pulses that correspond to the QRS complexes and arrive via line 102 are fed to the "interrupt" input of the microprocessor.
  • a loudspeaker 82 is connected to the output 104 of the microprocessor, which makes the respiratory arrest alarms which may have been triggered by the microprocessor audible.
  • the value of a signal is calculated in the microprocessor 93 (FIG. 9) or 103 (FIG. 10) every 1 ms by calculating the difference between two successive values of the respiratory signal.
  • FIG. 11 shows a typical form of the characteristic amplitude-frequency curve of the differentiating circuit 72 in FIGS. 7 to 9 and 12.
  • the center frequency of 3 Hz in FIG. 11 is only to be regarded as an example and is not a necessary condition of the method.
  • FIG. 12 shows a device in which the respiratory signal and the signal which is characteristic of the patient's electrocardiogram are obtained with the same electrode set 111, 112 and 113.
  • the floating amplifier 114 includes the means necessary to separate the respiratory signal from the signal representing the electrocardiogram, e.g. a filter 122 for the extraction of the respiratory signal and the series connection of an amplifier 123 and a filter 124 for the extraction of the signal representing the electrocardiogram.
  • These signals are delivered to separate outputs.
  • each of these signals can also be independent of the other, i.e. by using separate means.
  • the differentiating circuit 72 can be replaced by filtering means which have a similar transfer function.
  • FIG. 13 shows a second embodiment of the method according to the invention.
  • an interrupted hori zonal line represents the baseline of each of the signals shown.
  • the occurrence of the individual QRS complexes of the electrocardiogram is each represented by a broken vertical line.
  • the respiratory signal is "clamped" each time a QRS complex is detected.
  • a signal 131 is thus formed, the waveform of which corresponds to that of the respiratory signal in the intervals between successive QRS complexes, but which assumes the value zero each time a QRS complex is detected.
  • the amplitude values that the signal 131 assumes at the times in which the QRS complexes occur are compared with predetermined threshold values 132, 132.
  • FIG. 14 shows a schematic representation of a device for carrying out the method illustrated in FIG. 13.
  • This device enables the breathing signal supplied on line 71 to be “clamped” in an analog manner.
  • the device comprises a connection capacitance 141 and a switch 142. In order to "clamp” the signal, this switch is briefly closed when a QRS complex occurs. Closing switch 142 is controlled by a pulse that is characteristic of a QRS complex. This control is indicated in FIG. 14 by the broken line 142.
  • the clamped respiratory signal 131 is fed via a line to an analysis circuit (not shown in FIG. 14) which triggers a breathing arrest alarm if the amplitudes of the signal 131 do not exceed the threshold values 132, 133 during a predetermined period of time.
  • the function of the device shown in FIG. 14 can also be implemented with the aid of a microprocessor.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Cardiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Physics & Mathematics (AREA)
  • Public Health (AREA)
  • Pulmonology (AREA)
  • Physiology (AREA)
  • Artificial Intelligence (AREA)
  • Computer Vision & Pattern Recognition (AREA)
  • Psychiatry (AREA)
  • Signal Processing (AREA)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
EP86110522A 1985-08-21 1986-07-30 Surveillance de la respiration Expired - Lifetime EP0212370B1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
CH358885 1985-08-21
CH3588/85 1985-08-21

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EP0212370A2 true EP0212370A2 (fr) 1987-03-04
EP0212370A3 EP0212370A3 (en) 1988-05-04
EP0212370B1 EP0212370B1 (fr) 1990-03-21

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EP86110522A Expired - Lifetime EP0212370B1 (fr) 1985-08-21 1986-07-30 Surveillance de la respiration

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US (1) US4757824A (fr)
EP (1) EP0212370B1 (fr)
JP (1) JPS6244265A (fr)
DE (1) DE3669647D1 (fr)

Cited By (4)

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FR2652255A1 (fr) * 1989-09-22 1991-03-29 Centre Nat Rech Scient Appareil de surveillance et de mesure de l'activite respiratoire d'un patient.
EP0706808A1 (fr) * 1994-09-21 1996-04-17 Medtronic, Inc. Appareil pour le traitement synchronisé de l'apnée pendant le sommeil
CN112155560A (zh) * 2020-10-15 2021-01-01 国微集团(深圳)有限公司 基于实时心冲击信号的呼吸暂停检测方法及系统
CN114027853A (zh) * 2021-12-16 2022-02-11 安徽心之声医疗科技有限公司 基于特征模板匹配的qrs波群检测方法、装置、介质及设备

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DE3669647D1 (de) 1990-04-26
JPH0347098B2 (fr) 1991-07-18
EP0212370B1 (fr) 1990-03-21
EP0212370A3 (en) 1988-05-04
JPS6244265A (ja) 1987-02-26
US4757824A (en) 1988-07-19

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